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Amalgams are silver-colored metal fillings. 50% mercury by volume. It has been estimated that up to 14% of the metal waste in the oceans is from dental amalgam. Its use has been banned entirely in Norway, Denmark and Sweden. In September 2020 an article published in the Journal of Environmental and Public Health stated that mercury pollution has become an issue of global concern, citing the UN sponsored Minamata Convention in 2013. 128 countries, including the United States, have said ‘yes’ to the Treaty guidelines for mercury emissions.

Mercury has been identified as a neurotoxin that can cross the blood brain barrier, and it is the second most toxic metal after plutonium. The State of California listed mercury as a toxic element under Proposition 65, because it can cause birth defects or other reproductive harm. Here is the actual link to the Prop 65 website listing the mercury warning. Prop 65 recommends limiting exposure to mercury and mercury compounds during pregnancy, because it can affect brain development and cause learning and behavior problems in a child. 

These days less and less dentists are recommending amalgams as the filling of choice, offering more choices for composites (white fillings) and porcelain caps/crowns. However, every week it seems a patient comes in who tells me that their previous dentist is still offering amalgams as being durable, safe and effective for filling cavities. Granted amalgams are easy to place, inexpensive and long lasting. However and unfortunately, amalgam fillings usually outlast the teeth they are placed in. They will microscopically contract and expand with temperature over time, weakening, staining and sometimes breaking the tooth.

Amalgams Crack Teeth, if Left in Too Long

Metal fillings cause tooth crackingIf you look at the picture to the right, you will see what I’m talking about. This tooth just had the silver amalgam removed. As you can see the tooth is cracked and stained dark. This is due to the fact that amalgams are metal and the tooth still flexes during chewing. In essence the tooth cracks around the metal filling until these stress cracks cause the tooth to break. If the tooth breaks due to these cracks, it will need to be crowned or capped. Some dentists will also recommend that a root canal be done. And in severe cases of breakage the tooth may even need to be removed or extracted. Certainly after 30 or 40 years, these old amalgam/metal fillings should be removed and replaced with more biofriendly composites or porcelain. Nothing lasts forever, including metal fillings!

Safe amalgam removal is imperative because you don’t want to swallow it or breathe it into your body.

Safe metal removalIn the picture to the left, you can see the protocol we use at Integrative Dentistry for removal of all metal fillings. First we use a rubber dam which is the blue flexible sheet of nitrile, which is non latex, that fits over the teeth being worked on. This isolates the teeth being worked on from the rest of the mouth so no mercury is swallowed while the metal fillings are being drilled out. Also, we use a nose piece with fresh air from a medical grade O2 tank for the patient to breathe so they don’t breathe in any of the fumes of mercury released into the environment. The last thing we do is filter the air in the operatory with 2 high speed suction hoses that are attached to Hepa and charcoal filters in addition to using the negative pressure fan to remove the air in the room all during the procedure.

There are other things we do as well, but these are the main things. The protocols that Dr O uses and the degree of protection that’s unique to our practice. Our commitment at Integrative Dentistry is to minimize or remove exposure to toxic metals and other toxic dental materials for both our patients and our staff.  

It was these safety standards that allowed us to remain open during the pandemic lockdown, along with implementing other measures like the mandatory personal protective equipment (PPE) for the doctors and staff. An antiviral iodine rinse is provided for every patient before each procedure. In addition, negative pressure was installed in our operatories. This means all the air is removed and replaced with fresh air between appointments, so there is little chance of exposure to microbes in the air. This is the same strategy that hospitals use to exchange air in their clean rooms.

Example of Safe Amalgam Removal A-Z

Here is a single amalgam in the mouth

Here is the same tooth with the rubber dam on for protection

Here is the same tooth after the metal was removed and a white composite was placed

Here is what the finished tooth looks like. Nice!

Want Another Example?

Teeth With Multiple Amalgams

Rubber Dam On

Amalgams Replaced

Final Result

One More?

Replacing old amalgams

Multiple Mercury Amalgams

Rubber dam

Rubber Dam On

Amalgam removal

Final Restorations

I think these pictures tell the story of how mercury/amalgam fillings are removed at our practice and how we keep are patients safe from exposure. We also do amalgam replacement using only bio-friendly materials. To learn more visit us at myholisticdentist.com or contact us at 760-632-1304.